Differential sensitivity of intraindividual variability dispersion and global cognition in the prediction of functional outcomes and mortality in precariously housed and homeless adults.

OBJECTIVE: To examine cognitive intraindividual variability (IIV) dispersion as a predictor of everyday functioning and mortality in persons who are homeless or precariously housed. METHOD: Participants were 407 community-dwelling adults, followed for up to 13 years. Neurocognition was assessed at baseline and IIV dispersion was derived using a battery of standardized tests. Functional outcomes (social, physical) were obtained at baseline and last follow-up. Mortality was confirmed with Coroner's reports and hospital records (N = 103 deaths). Linear regressions were used to predict current social and physical functioning from IIV dispersion. Repeated measures Analysis of Covariance were used to predict long-term change in functioning. Cox regression models examined the relation between IIV dispersion and mortality. Covariates included global cognition (i.e. mean-level performance), age, education, and physical comorbidities. RESULTS: Higher IIV dispersion predicted poorer current physical functioning (B = -0.46 p = .010), while higher global cognition predicted better current (B = 0.21, p = .015) and change in social functioning over a period of up to 13 years (F = 4.23, p = .040). Global cognition, but not IIV dispersion, predicted mortality in individuals under 55 years old (HR = 0.50, p = .013). CONCLUSIONS: Our findings suggest that indices of neurocognitive functioning (i.e. IIV dispersion and global cognition) may be differentially related to discrete dimensions of functional outcomes in an at-risk population. IIV dispersion may be a complimentary marker of emergent physical health dysfunction in precariously housed adults and may be best used in conjunction with traditional neuropsychological indices.

Examination of bidirectional associations between neurocognitive functioning and housing stability in homeless adults: A longitudinal subgroup analysis of the at Home/Chez Soi study.

OBJECTIVE: Homeless adults represent a marginalized group with numerous psychiatric and physical illness risk factors for poor functional outcomes. This study investigated bidirectional associations between housing stability and neurocognitive functioning in homeless adults using a longitudinal study design. METHOD: Participants were homeless adults with serious mental illness from the At Home/Chez Soi study Toronto site who participated in a randomized control trial of Housing First. Participants underwent a comprehensive structured baseline interview and clinical evaluation. Up to four brief cognitive evaluations were completed over a period of up to 6 years. Housing status was ascertained every 3 months during the study period. RESULTS: The analysis included 283 participants with at least one follow-up evaluation (Mage = 41 years, 70% men). In an adjusted time-lagged mixed-effects logistic regression model, higher verbal learning and memory performance (OR = 1.71, 95% CI [1.16, 2.52], p = .007), but not cognitive flexibility and processing speed, was associated with an increased likelihood of being stably housed in the subsequent 3 months. In a test of reverse associations, mixed-effects linear models did not reveal associations between housing stability in the preceding 3 months and neurocognitive functioning in either domain. CONCLUSIONS: These results suggest verbal learning and memory functioning is a key contributor to housing stability among homeless adults with serious mental illness. This work has important implications for health services that support individuals transitioning into stable housing and for the attainment of long-term functional independence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Procognitive Effects of Antidepressants and Other Therapeutic Agents in Major Depressive Disorder: A Systematic Review.

OBJECTIVE: To review the efficacy of antidepressants and other therapeutic agents for the treatment of cognitive impairment in adults with major depressive disorder (MDD). DATA SOURCES: We conducted a database search of MEDLINE, PsycINFO, and Embase through Ovid on May 7, 2019. The year of publication was not restricted. The search terms "Major Depressive Disorder," "depress*," "cognit*," and "therapeutics" were used. STUDY SELECTION: The studies included in this review were clinical trials of antidepressants and other therapeutic agents in MDD populations. Participants were aged between 18 and 65 years and had a DSM-III, -IV, or -5 diagnosis of MDD. In total, 2,045 research papers were screened, 53 full-text articles were assessed, and 26 articles were eligible to be included in this systematic review. DATA EXTRACTION: The data and quality of research papers were assessed and screened by 2 independent reviewers. Discrepancies were resolved through a third reviewer. RESULTS: Overall, studies demonstrated that tricyclic antidepressants do not have procognitive effects, while vortioxetine and bupropion have demonstrated procognitive effects in MDD populations relative to selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Several non-antidepressant agents, such as modafinil, amphetamines, and erythropoietin, have also demonstrated significant positive effects on cognition in depression. CONCLUSIONS: Present-day antidepressants and other agents have demonstrated procognitive effects in MDD, but the findings between various agents are mixed. Further research looking at objective measures of cognitive performance would be helpful to obtain more definitive results regarding the efficacy of therapeutics for cognitive impairment in MDD.